Recipient and Donor Factors Impacting Head and Neck Squamous Cell Carcinoma Risk After Transplant

OBJECTIVE: Solid organ transplant (SOT) recipients carry an increased risk of head and neck squamous cell carcinoma (HNSCC); however, the specific factors that modulate this risk remain incompletely characterized. This study evaluates recipient and donor characteristics associated with HNSCC in a national transplant registry. METHODS: This is a retrospective cohort study of patients who underwent solid organ transplant in the United States, with data inputted to the Scientific Registry of Transplant Recipients (SRTR). HNSCC was defined as SCC of the head, neck, lip, oral cavity, tongue, or larynx. Multivariable logistic regression analysis was performed to assess the likelihood of HNSCC development according to select donor factors and characteristics. RESULTS: N = 114,691 patients were included for analysis, with N = 14,706 of those having HNSCC. Recipient male sex (OR = 2.06, 95% CI: 1.96-2.17), prior transplant (OR = 1.50, 95% CI: 1.41-1.60), recipient smoking (OR = 1.40, 95% CI: 1.26-1.56), donor history of heavy smoking (OR = 1.50, 95% CI: 1.43-1.58) and donor status (deceased vs. live donor) (OR = 0.73, 95% CI: 0.68-0.79) were significantly associated with HNSCC development. No significant association was observed according to EBV positive donor (OR = 1.00, 95% CI: 0.89-1.12), donor malignancy history (OR = 0.97, 95% CI: 0.84-1.13), ABO incompatibility (OR = 0.73, 95% CI: 0.46-1.15) or donor sex (OR = 0.96, 95% CI: 0.96-1.00). CONCLUSION: In this national registry analysis, both donor and recipient characteristics were associated with post-transplant HNSCC risk. These findings may inform surveillance protocols and guide individualization of immunosuppression regimens in higher-risk recipients.